title: Lateral parapatellar approach with tibial tubercle osteotomy for the treatment of non-correctable valgus knee osteoarthritis: a retrospective clinical study.
abstract: BACKGROUND
  The aim of this retrospective study was to evaluate the efficacy of a lateral parapatellar approach combined with a tibial tubercle osteotomy (TTO) in patients undergoing total knee arthroplasty (TKA) with non-correctable valgus knee osteoarthritis.
  
  
  METHODS
  We studied 53 consecutive patients (57 knees) who had a primary TKA via lateral parapatellar approach with a global step-cut "coffin" type TTO over a 10-year period. All patients had non-correctable grade II valgus deformity according to the Ranawat classification. The average age of patients was 71 years (45 to 77) and the mean follow-up was 39 months (20 to 98).
  
  
  RESULTS
  Post-surgery, there was a significant improvement in knee extension (p=0.002), flexion (p=0.006), Knee Society Pain and Function Scores (p<0.001) and WOMAC Osteoarthritis Index (p<0.001). The tibiofemoral angle changed from a preoperative median value of 11 deg (10 to 17) to a postoperative value of 3.75 deg (0 to 9). Congruent patellar tracking was observed in all cases. All but one osteotomy united in a median period of 16.7 weeks (9 to 28) and no hardware removal was required. One knee developed infection treated with two-stage reconstruction. A proximal tibial stress fracture also occurred in a patient on long-term bisphosphonate therapy.
  
  
  CONCLUSIONS
  Lateral parapatellar approach along with TTO is an effective technique for addressing non-correctable valgus knee deformity during TKA.
authors.affiliation: Malabar Orthopaedic Clinic, 43 The Avenue, Windsor 3181, Melbourne, Australia. Electronic address: byronchalidis@gmail.com.
authors.forename: Byron E
authors.initials: BE
authors.lastname: Chalidis
authors.affiliation: Malabar Orthopaedic Clinic, 43 The Avenue, Windsor 3181, Melbourne, Australia.
authors.forename: Ken
authors.initials: K
authors.lastname: Ye
authors.affiliation: Malabar Orthopaedic Clinic, 43 The Avenue, Windsor 3181, Melbourne, Australia.
authors.forename: Nick P
authors.initials: NP
authors.lastname: Sachinis
authors.affiliation: Malabar Orthopaedic Clinic, 43 The Avenue, Windsor 3181, Melbourne, Australia.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Hawdon
authors.affiliation: Malabar Orthopaedic Clinic, 43 The Avenue, Windsor 3181, Melbourne, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: McMahon
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000601:surgery; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016916:Joint Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000601:surgery; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*
keywords: Knee osteoarthritis; Lateral parapatellar approach; Tibial tubercle osteotomy; Total knee arthroplasty; Valgus deformity